Primary idiopathic chylopericardium: a retrospective case series

Han, Zhijun; Li, Shanqing; Jing, Hongli; Liu, Huan

doi:10.1186/s12893-015-0047-8

Cited by 24 publications

(30 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Causes of CP include congenital mediastinal lymphangiectasia, iatrogenic development following cardiac surgery, malignant tumors, blunt or penetrating trauma, infection and congenital lymphatic anomalies (6,11,(13)(14)(15). It has been reported that ~56% of cases are idiopathic (6), and only ~100 CP cases have been reported worldwide (16). In the present study, a systematic review of the literature was performed to analyze the etiology, symptoms, physical examination features, laboratory findings, imaging, type of surgery and follow-up data of primary CP cases.…”

Section: Discussionmentioning

confidence: 99%

Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

View full text Add to dashboard Cite

Abstract. Primary chylopericardium (CP) is a rare clinical condition in which chylous fluid containing high concentrations of triglyceride accumulates in the pericardial cavity. The present study reports a case of CP that was successfully treated by reconstruction surgery of thoracic duct. To improve the ability to diagnosis and treat this rare disease, the current study also systematically extracted 104 reported cases of primary or idiopathic CP from the past 60 years (January 1950 to December of 2015), and reviewed the clinical manifestation, etiology, diagnosis and treatment of these cases. The age at diagnosis varied between 6 weeks and 79 years with a mean age of 27.95±16.50 years. Asymptomatic patients accounted for 39.42% of cases, while the most common initial symptoms were dyspnea (44.23%) and coughing (10.58%). Jugular venous distention and distant heart sound was identified in 23 (22.12%) and 34 cases (32.69%), respectively. Cardiomegaly in X-ray scans was detected in the majority of patients (93.27%). In addition, lymphoscintigraphy and lymphangiography were helpful in identifying the source of chyle. Regarding the etiology, idiopathic cases accounted for 35.56% of the included cases in the present study. The most important cause of primary CP was abnormal connection or accumulation of lymph fluid in the pericardium (37.50%). Conservative therapy included low-fat or medium-chain triglyceride diet, as well as total parenteral nutrition. The majority of patients (71.2%) required surgery for definitive therapy, and thoracic duct ligation was the most preferred surgical procedure, performed in 44.23% of cases. Follow-up was reported in 64 cases, and all patients survived during the mean follow-up period of 12 months. Therefore, it is suggested that surgical management is the most successful treatment method and is associated with a favorable prognosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

View full text Add to dashboard Cite

show abstract

“…Chylous transudate through small pathological channels between the thoracic duct and pericardial lymphatic ducts [12] was proposed as another cause. Other potential factors are valve damage and increased permeability of the thoracic duct [16].…”

Section: Discussionmentioning

confidence: 99%

“…If no obvious cause can be established, the entity is labeled primary idiopathic chylopericardium [17,18]. The primary idiopathic chylopericardium is a rare condition, with only 128 cases reported in 59 years from Groves and Effler´s description [18] until November 2013 [16]. The first report of chyle in the pericardial space dates back to 1888, when Hasebroeck K [19] reported 22.6 ml of such fluid found in the necropsy of a man dead from asphyxiation.…”

Section: Discussionmentioning

confidence: 99%

“…Signs and symptoms are not indicative of an underlying etiology [12] and chylopericardium may range from being asymptomatic [5,8,9] to having the clinical manifestations of a cardiac tamponade [12,21]. The most frequently described symptoms are cough, chest pain, dyspnea and fatigue [12,16,22] but in a recent literature review dyspnea was present in 53.90% followed by absent of symptoms (39.42%) and cough (10.58%) [1]. Cardiac tamponade is extremely rare [21,23].…”

Section: Discussionmentioning

confidence: 99%

“…Chylopericardium treatment is focused on preventing mechanical complications such as cardiac tamponade and constrictive pericarditis, preventing or treating metabolic and immune consequences, stopping lymphatic leaks and reducing recurrence. In the first instance, non surgical actions are required, such as pericardiocentesis, pericardial drainage, low-fat diet with medium-and short-chain triglycerides, total parenteral nutrition and octreotide [16]. Pericardiocentesis with pericardial fluid drainage prevents mechanical complications by reducing intrapericardial pressure, improving preload and, therefore, systolic volume.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Aranalde¹,

Lorenzin²,

Cánaves³

et al. 2019

AJIM

View full text Add to dashboard Cite

The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.

show abstract

Spontaneous chylopericardium in an adult due to mediastinal cystic hygroma

Reddy

2021

Indian J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Primary idiopathic chylopericardium: a retrospective case series

Cited by 24 publications

References 18 publications

Primary chylopericardium: A case report and literature review

Primary chylopericardium: A case report and literature review

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Spontaneous chylopericardium in an adult due to mediastinal cystic hygroma

Contact Info

Product

Resources

About